Welcome to Women in Charge-- a birth blog project of Wisewoman Childbirth Traditions. This blog is here to empower and encourage women to take charge of their bodies, their babies and their births. Women are powerful and women are strong. We are in charge.

Haiti Blog Aug 22 - 27, 2012

WEDNESDAY, AUGUST 22, 2012

First Shift at St. Therese

Ami and I worked in the hospital last night with 3 students: Suzette, Marie Rose and Sonis. I was surprised at my reaction this morning as we finished up our shift. I felt speechless and overwhelmed. In contrast to my ease with the orphanage and the flow of Haitian life, I felt despondent and discouraged at the familiar hospital scene. Three women gave birth in the wee hours of the morning after a slow start to our shift. With each one, I felt moments of regret; this shouldn’t be happening like this.

The first mother to give birth was a young, first timer who accidentally gave birth in the antepartum room. Antepartum, postpartum and post-op are large rooms with 12 beds, one woman to a bed. The rooms were completely full all night. The other two women who gave birth through the night had to stay in the labor ward because we had no empty beds. The young mother gave birth almost painlessly. Her sister told us that she was sleeping when the baby started coming. The mother looked no more than 17 years old, although the midwife claimed she was 22.

She gave birth in the antepartum room, without opportunity for privacy or modesty. We had to clean up the baby and mother without the simple luxury of a partition or sheet to separate her from the other 11 women in the room. Thankfully, the baby was gwo e asante (big and healthy). As the midwife in charge rubbed the baby to a hearty cry, the mother looked away, disconnected and masked. Her face gave no hint of what thoughts lay within. This is a familiar response to birth in Haiti. The mothers seem overwhelmed and disconnected to their babies. The only explanation that I proposed my first year here was that there is so much infant death. Still birth, infant death, children not reaching the age of 5. Giving birth risks her own life as well. With such odds, mothers bond tentatively and slowly, too familiar with the pain of loss.

It is also poverty. I have no idea what it may mean for a mother to have a child here. We so rarely witness joy as a reaction to birth. A baby means another mouth to feed, school and clothe. An already impoverished family may not see a new baby as a blessing. My first year here, I tried to emphasize each healthy birth. We encouraged the mother to speak to and touch her child. “This baby is so big and healthy,” we would exclaim. “Look, how beautiful, a girl, a boy.” Could we possible teach a mother how to bond?

The other two births this morning also produced healthy babies. One woman had been literally wailing for what seemed like hours. She had been coming to the hospital for the last 5 days; a long, early labor that was possibly indicative of a posterior baby. At the peak of her labor, the midwife on staff examined her and said she was 5 cms dilated. I was outside at the time, trying to nap sitting up in a chair. I finally went in to really understand why this woman was literally screaming. She seemed to be pushing with each contraction. I asked again how far dilated she was and why she was pushing at 5 cms. The staff midwife, a student from the prior class, seemed disinterested in the pushing effort in front of her. I told them I wanted to do an exam. Sure enough, the woman was completely dilated and the baby was minutes away from being born. I felt disturbed by the lack of competence and follow through that ultimately led to a chaotic rush to prepare for the birth. This shouldn’t be happening this way.

When the woman actually gave birth, meconium-stained amniotic fluid flooded the floor and the top of my sneaker. The baby needed to be suctioned with a DeLee, which the students had never seen used before. I was glad to show them a new skill. Sonis did a fine job suturing.

The third mom was rushed also; a general understanding of preparedness will be our teaching theme for the week. Ami and I walked home at 6:30am, grateful for the 3 healthy babies, but not without noting the small, taped up cardboard box on the counter all night that stood sentinel to the truth that neonatal mortality is a constant tragedy here in Haiti.

*************************************************

Watson is a 7 year old orphan boy at Maison Fortune. His nick name is Wa Wa. Here is the letter that he “sent” me yesterday:

Kreyol Lesson

SUNDAY, AUGUST 26, 2012

Brother Harry is wearing a sweater this morning. I celebrated the weather as well and put on my one long-sleeve, travel shirt. The central plateau in Haiti never really gets the full effect of a hurricane because it is surrounded by mountains. The mountains break up the pressure system enough so that Hinche lives in relative weather security.

Yesterday as the hurricane began, we had a full 15 minutes of spectacular rainfall. The prepubescent boys stripped off their clothes and splashed around the outdoor basketball court. Others soaped up underneath a cascade coming from the roof drainage system of our two-story guest house and administration building. The soccer field flooded which was an invitation for two boys to slip around playing Frisbee in the rain. Nearly as quickly as the rain had started, it finished. Was that it?

We awoke in the middle of the night to fierce winds. Dina and I got up and took the clothes off of the line on the veranda. This morning it is cool and breezy with a light rain falling. The girls are wrapped in small blankets as they venture out of their dormitory. Maybe it is 70 degrees.

My second shift at the hospital was a constant barrage of births and medical crises. At one point, a pre-eclamptic woman gave birth unexpectedly in the antepartum room. Her premature baby lay lifeless on her chest when Ami joined the other midwives attending to the scene. No one seemed to be paying much attention to the baby. Ami immediately grabbed the child in a torn sheet and brought her into the labor ward to resuscitate her. I joined her in the effort.

We worked on the lifeless little one for at least 20 minutes. She was unresponsive and limp but her heart beat never faltered. She could have been that way because of the Magnesium Sulfate given to the mother for her pre-eclampic condition. The little girl looked to be only about 3 pounds, 36 weeks by dates but looking like a 32 or 33 weeker. At some point in the resuscitation we knew that we couldn’t just ventilate her forever. At some point, you just have to decide that you’ve done enough and see if the baby will breathe on her own. We let her try a couple of times, only to begin the resuscitation again. Eventually, however, she held her own tentative breathing pattern. Still, she had not responded to stimulation and her eyes were glossed over.

We watched her for over an hour before we started to think about bringing her back to her mother. Would the mother want to spend time with her baby who might have only a few hours to live? Would the baby survive a disruption of her stabilized state? Ami and I agreed that the baby was stable enough to move and that the mother should get a chance to see her alive and decide for herself what to do next.

The mother was lying emotionless on her cot in the antepartum room. We brought in the tiny child and lay her down next to her mother. The baby was snuggled inside a receiving blanket and just her little face was visible, her eyes were closed. The mother barely looked at her. When we discussed her daughter’s tentative vitality, she placed her arm over her eyes, hiding her response. We asked her whether she would like the baby to stay with her, or whether she wanted us to take the child back into the labor room with us for observation. She wanted us to take the baby away. We did and simply watched and waited to see if the baby would survive.

Within a couple of hours, it was clear that our little one was holding on and that she could safely stay with her mother without observation. Of course, this is all relative because in the states, this baby would have been in the NICU for weeks. We brought the baby back to the mother and they both slept. Whenever I went in to check on the baby, she was still breathing. By morning, she was opening and closing her eyes and moving around, just a bit. Without ongoing care, this one will have a hard time surviving the first week, the first month. But she survived through the night and that says a lot. In Haiti, one of the greetings is “N’ap kenbe” – we are holding on. Against all odds, the littlest Haitians embody their country’s affirmation of life.

The rest of the shift was a steady stream of mostly first timers. Two babies were stillborn and 3 babies were healthy. Honestly, I can’t exactly remember how many births we had that night. At one point, I took a 2 hour nap on the hard cement floor; the rest of the night was busy.

At the orphanage, we have been learning Creole with Kenel, the young man who is full of hope and potential. He just passed his 12th grade state finals which means that he is officially a high school graduate. We celebrated at a night club in town where a live band was playing Kompe music. He said it was his best night out ever.

Oday

During one of our Creole lessons, our favorite little boy, Oday, sat in with us which he is want to do. Distracted from the Creole lesson, Oday had figured out how to use the flashlight that hung from Dina’s belt loop. She said that she hadn’t known how to turn it on continuously and was glad that Oday had figured it out. Mind you, he’s 6 years old. He returned with the following question in Creole, “Pou ki sa ou te achte yon ti flach e ou pa konnen kijan ou kapab itilize li?” Why did you buy that little flashlight and you don’t even know how you can use it?

Postscript, Sunday August 26, 2012:Our little one, that we affectionately named "Miracle," lived for about 30 hours. We walked up to the hospital yesterday during a break in the rain to check on her condition. The midwife on duty told us that the baby had died around 6:00am. The family hadn't told the mother yet, only saying that the baby had been transported to a better hospital. As far as we could understand, they will tell the mother about the death once she is at home. Perhaps they are looking for some privacy to break the news. We told the mother's cousin that we had done everything that we could do, but that the baby was just to weak and little. We told her that we would pray for them.

No comments:

Welcome!

Welcome to Wisewoman Childbirth Traditions! If you are pregnant, live in San Francisco, and are interested in a homebirth, please contact me. You can email me at sfmidwife@yahoo.com or you can click the link below to schedule an appointment. I look forward to meeting you!